Hello, I need some advice (sleep apnea)

[FromCali]

Hi guys,

I'm new here and first off I would really appreciate it if you could help me learn some elementary stuff about the anatomy of the skull and some of the important/well-known surgeries that are used to alleviate craniofacial deficiences (mostly osteotomies).

The main issue is that I have obstructive sleep apnea. I was diagnosed after an at-home sleep study indicating blood oxygen levels of 91%. This was in 2014 and I obtained a CPAP device which I have been using, but I am skeptical of its efficacy to be honest. I recently saw my sleep doctor again (not a surgeon) and he agreed to get me another sleep study done at the lab this time. He also said that at-home sleep studies always underestimate the severity of sleep apnea. Judging from that statement, I'd say I probably have a blood oxygen level of 89% or less, which would be moderate sleep apnea. This terrifies me because I have a condition, at age 22, which could lead to me having cardiovascular or even cognitive issues.

What's really disappointing about this is that I feel like every single doctor that I've seen so far keeps trying to make surgery the last resort, which I understand, but I think it's really time to consider surgery seriously. In 2014, after getting diagnosed, I was referred to an Ear, Nose and Throat (ENT) doctor who is a surgeon who recommended that I try CPAP first, which I have been using and I think fails because I always open my mouth at night.

I know, deep down, that surgery, probably maxillomandibular advancement, would probably the single most effective treatment to eradicate this darn health problem. I don't want to have to live with a machine or an oral appliance for the rest of my life, it's horrible and to be honest completely "unsexy," as shallow as it sounds. It will be difficult getting a girlfriend or a wife if I have to wear these devices for the rest of my life - there's no denying that. Some users with much more serious problems might think I'm being childish, but I really just want this problem gone forever. Gone. I just want it completely gone.

However, there are complications here.
1) I'm not sure insurance (I'm on Medicaid) would be willing to pay for maxillomandibular advancement
2) Even if I got the operation, it consists of a BSSO and a Lefort I procedure, right? I already have somewhat recessed infraorbitals so I'm afraid I'll look like a chimp afterwards. I really don't want to look bad because of a surgery

Ideally, I would get an effective soft tissue surgery or theoretically a BSSO + Lefort 2 (instead of Lefort 1) osteotomy. This would solve my problem while not making me look odd, correct? I would really appreciate feedback here. Thank you so much

[FromCali]

Bump. I would really like to hear some of your advice regarding jaw surgery for sleep apnea, and who I should visit to get a consult (I live in California)

[PloskoPlus]

Bump. I would really like to hear some of your advice regarding jaw surgery for sleep apnea, and who I should visit to get a consult (I live in California)

Gunson, Relle

[FromCali]

Gunson, Relle

What about Dr. Stephen Schendel? He practices near me, in Palo Alto. What's the word on the street about him?

[ditterbo]

What about Dr. Stephen Schendel? He practices near me, in Palo Alto. What's the word on the street about him?

Bad news.

[FromCali]

Bad news.

People keep saying that. I'm astounded that one can become Professor Emeritus of Surgery at Stanford while being a bad surgeon. How does that happen?

[PloskoPlus]

People keep saying that. I'm astounded that one can become Professor Emeritus of Surgery at Stanford while being a bad surgeon. How does that happen?

In theory there is no difference between theory and practice, in practice there is.

[Bobbit]

Hi guys,

I'm new here and first off I would really appreciate it if you could help me learn some elementary stuff about the anatomy of the skull and some of the important/well-known surgeries that are used to alleviate craniofacial deficiences (mostly osteotomies).

The main issue is that I have obstructive sleep apnea. I was diagnosed after an at-home sleep study indicating blood oxygen levels of 91%. This was in 2014 and I obtained a CPAP device which I have been using, but I am skeptical of its efficacy to be honest. I recently saw my sleep doctor again (not a surgeon) and he agreed to get me another sleep study done at the lab this time. He also said that at-home sleep studies always underestimate the severity of sleep apnea. Judging from that statement, I'd say I probably have a blood oxygen level of 89% or less, which would be moderate sleep apnea. This terrifies me because I have a condition, at age 22, which could lead to me having cardiovascular or even cognitive issues.

What's really disappointing about this is that I feel like every single doctor that I've seen so far keeps trying to make surgery the last resort, which I understand, but I think it's really time to consider surgery seriously. In 2014, after getting diagnosed, I was referred to an Ear, Nose and Throat (ENT) doctor who is a surgeon who recommended that I try CPAP first, which I have been using and I think fails because I always open my mouth at night.

I know, deep down, that surgery, probably maxillomandibular advancement, would probably the single most effective treatment to eradicate this darn health problem. I don't want to have to live with a machine or an oral appliance for the rest of my life, it's horrible and to be honest completely "unsexy," as shallow as it sounds. It will be difficult getting a girlfriend or a wife if I have to wear these devices for the rest of my life - there's no denying that. Some users with much more serious problems might think I'm being childish, but I really just want this problem gone forever. Gone. I just want it completely gone.

However, there are complications here.
1) I'm not sure insurance (I'm on Medicaid) would be willing to pay for maxillomandibular advancement
2) Even if I got the operation, it consists of a BSSO and a Lefort I procedure, right? I already have somewhat recessed infraorbitals so I'm afraid I'll look like a chimp afterwards. I really don't want to look bad because of a surgery

Ideally, I would get an effective soft tissue surgery or theoretically a BSSO + Lefort 2 (instead of Lefort 1) osteotomy. This would solve my problem while not making me look odd, correct? I would really appreciate feedback here. Thank you so much

You can go to Walgreen's and get a finger pulse oxymeter - -  that records overnight and is bluetooth downloadable to your computer.   You can plot your  heart rate and sp02 for the entire night on your computer with downloadable software.  The software was lousy - -  but it worked when I did it about 2 years ago.   It is probably better now.

Do that for a few days and you will know more about your sleep apnea than any one night sleep study in a clinic bed will ever tell you.

From that,  you can have a very very good idea as to how you are doing  WRT  sleep apnea.   In my opinion,  it should put the high dollar sleep apnea medical testing out of business.

The cost is right.   Somewhere around 35 to 50 $ if I recall.   

When I did it,  I used some tape to secure it on my finger so it would not fall off overnight.   Worked REALLY well.

[ditterbo]

Holy crap thanks for telling us about this. I'll go about and get one for sure.  Struggling with CPAP compliance but day to day data will definitely help paint the full picture and motivate.

[FromCali]

You can go to Walgreen's and get a finger pulse oxymeter - -  that records overnight and is bluetooth downloadable to your computer.   You can plot your  heart rate and sp02 for the entire night on your computer with downloadable software.  The software was lousy - -  but it worked when I did it about 2 years ago.   It is probably better now.

Do that for a few days and you will know more about your sleep apnea than any one night sleep study in a clinic bed will ever tell you.

From that,  you can have a very very good idea as to how you are doing  WRT  sleep apnea.   In my opinion,  it should put the high dollar sleep apnea medical testing out of business.

The cost is right.   Somewhere around 35 to 50 $ if I recall.   

When I did it,  I used some tape to secure it on my finger so it would not fall off overnight.   Worked REALLY well.

Amazing post, thank you so much. The reason I'm getting another sleep study done is to have it permanently appended to my medical record, can this take-home thing from Walgreen's be appended to your medical record?

[Bobbit]

Amazing post, thank you so much. The reason I'm getting another sleep study done is to have it permanently appended to my medical record, can this take-home thing from Walgreen's be appended to your medical record?

That is what I did.  I printed out the data for the 10 hour sleep period for several days.   Took that to the doctor.  He looked at it and said - -  "Oh!  that is pretty clear."

When you have an episode of apnea,  the plotted data will show a periodic declining  spo2 and a corresponding increase in heart rate (trying to compensate).   

When I last did this,  the software download was not very user friendly,  but I finally got it to work.  It should be better now.

[CCW]

People keep saying that. I'm astounded that one can become Professor Emeritus of Surgery at Stanford while being a bad surgeon. How does that happen?

That doesn't mean you're actually a good surgeon. You're just are well-liked and know the right people.